Koichi Miyakawa

Juntendo University, Edo, Tōkyō, Japan

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Publications (10)17.08 Total impact

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    ABSTRACT: Patients with advanced-stage Parkinson's disease (PD) occasionally experience refractory depression or catatonic stupor. Electroconvulsive therapy (ECT) has been reported as a successful procedure for both severe psychosis and motor symptoms in patients with PD. Four patients with PD who were receiving ECT were quantitatively evaluated using the Unified PD Rating scale part III, Hoehn and Yahr scale, Barthel index, Neuropsychiatric Inventory, mini-mental state examination, Revised Hasegawa's Dementia scale, Beck's Depression Inventory, and Hamilton Rating Scale for Depression-17. We adopted the "half-age" method, which is an age-based stimulus-dosing method. The patients showed improvement in symptoms of psychosis and motor symptoms without any adverse effects. The interval of improvement after ECT varied among patients. Of note, a decrease in psychiatric symptoms successfully alleviated the burden of caregivers. ECT may be useful to treat parkinsonism with refractory psychosis, major depression, or catatonic stupor, within the limitations of the patients enrolled.
    Journal of Neural Transmission 04/2014; · 3.05 Impact Factor
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    ABSTRACT: The case of a 64-year-old patient with pica and severe mental retardation who was admitted to our hospital for treatment of recurrent cholecystitis is reported. Abdominal ultrasound showed sludge in the gallbladder, but no stones. Abdominal CT revealed a foreign body in the duodenum resembling a suction cup of the type commonly used in kitchens and bathrooms. The object could not be removed because it was deeply embedded in the hypertrophic intestinal mucosa. A nasogastric tube was inserted for feeding, since the object impeded the passage of solid foods. The patient's fever and abdominal pain subsequently resolved, and laboratory data improved. The indwelling feeding tube prevented recurrence of cholecystitis. Since pica is common not only in patients with mental retardation but also in dementia patients, the present case may also relate to the treatment of acute abdominal conditions in dementia patients.
    Psychogeriatrics 12/2011; 11(4):244-6. · 1.26 Impact Factor
  • Masanobu Ito, Kotaro Hatta, Koichi Miyakawa, Heii Arai
    Acta Neuropsychiatrica 01/2011; 23(6). · 0.61 Impact Factor
  • Masanobu Ito, Kotaro Hatta, Koichi Miyakawa, Heii Arai
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    ABSTRACT: To discuss the risk that bladder distention resulting from anticholinergic side effects of antipsychotics can cause iliac vein compression syndrome (IVCS) and subsequent pulmonary embolism (PE). Case report, review of the literature and discussion. We report the case of a 65-year-old man with depression who experienced PE associated with IVCS due to a distended urinary bladder resulting from anticholinergic side effects. PE disappeared after conservative therapy with heparin followed by warfarin. When drugs with anticholinergic effects are given to immobilized patients such as those with severe depression, close observation including monitoring of urine volume is needed to prevent IVCS caused by drug-induced urinary retention, and subsequent PE.
    General hospital psychiatry 01/2009; 31(2):187-9. · 2.67 Impact Factor
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    ABSTRACT: Background:  Alzheimer's disease (AD) is common in the Japanese population. In 1999, donepezil was authorized in Japan for the treatment of AD. However, because the time since donepezil was authorized is relatively short, there are few reports regarding the long-term effects of donepezil in Japanese AD patients.Methods:  In the present study, the clinical features of 72 AD patients treated at Juntendo University Urayasu Hospital were examined retrospectively in order to examine the long-term effects of donepezil. Sixty-two AD patients had been administrated donepezil. The effect of donepezil was evaluated using the Revised Hasegawa Dementia Scale (HDS-R). In patients with increased points on the HDS-R after 6 months, treatment was regarded as effective, whereas patients in whom there was no change in points on the HDS-R were classified as ‘no change’; finally, in patients with decreased points on the HDS-R after 6 months, treatment was regarded as non-effective.Results:  The duration of medication was divided into four groups: (i) 6 months (16 cases; 26%); (ii) 1 year (16 cases; 26%); (iii) 2 years (13 cases; 21%); and (iv) more than 3 years (11 cases; 18%). Donepezil treatment was stopped in six patients (10%) because of adverse effects. Thus, the 56 patients who continued with donepezil treatment were categorized as follows: treatment was effective in 27 cases (48%), no change was found in five cases (9%) and, in 24 cases (43%), donepezil treatment was found to be non-effective. Differences in treatment efficacy were not related to sex, apolipoprotein E genotype or medical history. Comparative studies for the age of onset of AD and points of the HDS-R before administration of donepezil suggest that donepezil tended to be effective in patients in whom AD developed at 71–80 years of age and with 16–20 points of the HDS-R. In patients in whom donepezil was effective, cognition returned to the state before treatment 2 years later. However, the marked degradation of points on the HDS-R was not seen in these cases. Conversely, the long-term consequences for patients in whom donepezil was not effective after 6 months were similar to those for patients not treated with donepezil.Conclusion:  Donepezil improved the dementia symptoms in patients in whom it was effective over the long term. We suggest that the presence of drug efficacy after 6 months is an indicator that long-term treatment with donepezil is warranted. In particular, donepezil was effective in cases with mild to moderate AD.
    Psychogeriatrics 02/2008; 8(1):19 - 23. · 1.26 Impact Factor
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    ABSTRACT: Because the number of medical lawsuits has recently increased in Japan, doses of medication above the upper limits have recently been avoided, even when treating catatonic patients. We treated catatonic symptoms with drugs within the upper limit of dosage and electroconvulsive therapy (ECT) to determine the maximal response. We examined 50 consecutive patients with catatonic symptoms admitted to a university hospital during a 32-month period who were treated with either drugs within the upper limit or ECT. Response rates were as follows: ECT, 100%; chlorpromazine, 68%; risperidone, 26%; haloperidol, 16%; and benzodiazepines, 2%. The findings indicated that ECT is the treatment of choice for catatonic symptoms.
    Journal of Ect 01/2008; 23(4):233-5. · 1.69 Impact Factor
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    ABSTRACT: A 76-year-old woman was scheduled to receive 8 treatments of electroconvulsive therapy (ECT) for severe depression. Although she experienced no adverse consequences in the first 2 treatments, giant T-wave inversion ensued from the third treatment despite no change in anesthesia or technical parameters of ECT. T-wave inversion appeared to have almost disappeared 8 days after the third ECT, but reappeared at 3 weeks after treatment during severe pain from gallbladder stone. T-wave inversion lasted for 4 months with gradual attenuation. Exaggerated sympathetic stimulation associated with ECT as physical and emotional stressors might have played a role in the appearance of T-wave inversion similar to catecholamine-induced cardiomyopathy. Furthermore, reappearance of T-wave inversion may have been involved in additive effects of pain from gallbladder stone on vulnerability due to a catecholamine-induced cardiomyopathy-like condition.
    Journal of Ect 10/2007; 23(3):194-7. · 1.69 Impact Factor
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    Psychiatry and Clinical Neurosciences 11/2006; 60(5):644. · 2.04 Impact Factor
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    ABSTRACT: A newly developed quantitative near-infrared spectroscopy (NIRS) system was used to measure changes in cortical hemoglobin oxygenation during the Verbal Fluency Task in 32 healthy controls, 15 subjects with mild cognitive impairment (MCI), and 15 patients with Alzheimer's disease (AD). The amplitude of changes in the waveform, which was quantitatively calculated by a signal processing method, was significantly lower in the frontal, and the bilateral parietal areas in the AD group, whereas that in the MCI group was significantly lower only in the right parietal area. The NIRS system may be a potential tool for the primary screening of AD.
    Brain and Cognition 08/2006; 61(2):189-94. · 2.82 Impact Factor
  • Article: P1-294
    Alzheimers & Dementia - ALZHEIMERS DEMENT. 01/2006; 2(3).